Alzheimer's Disease: Progressively

Forgetting

By:- Dr Amitabha Ghosh

 We all forget where we kept that box of firecrackers, or the

bill that needs to be paid. But there is a more serious loss
of memory that progressively begins to disrupt one's
normal day-to-day functions. Alzheimer's disease is the
commonest form of dementia, a disease of old age, and
becomes increasingly frequent with every passing decade
after 60 years.

Over the age of 80, more than 20% of people have mild
dementia. Currently, over 3 million people suffer from
dementia in India alone. In about 20 years time, the
numbers are expected to double, thanks to a greater lifespan and to better identification of patients in large areas
of our country.

The impact
Many elderly couples live alone these days. They are frail and
particularly vulnerable. Their children may not live close by
and could even be in a different country altogether, finding it
difficult even to come down for Diwali. What would be the
impact of Alzheimer's disease in such a couple?
Imagine the pain of seeing your partner slowly forget
everything that was once special and precious to you.
Forgetting all likes and dislikes, friends and relatives, or how
to be happy or sad. And one day, even forgetting who you
are! Imagine your helplessness on being left alone, caring for
the one you care for most, but not knowing how to care. And
then there is the grocery, the banks, the pension, the medical
bills, all that for you to sort out. You are old and frail yourself
but there is no time for all that. Medicines help a bit, but for
you there are no balms of comfort. Such is the impact of
Alzheimer's disease. It affects two people - the patient, but
enormously more, the caregiver.

Alzheimer's is not an obscure illness but an ailment

affecting real people in real families like yours and mine.
I want you to learn to recognise the signs of Alzheimer's
disease, but at the same time be reassured that all
forgetfulness is not dementia.

Facts about forgetting

We all forget things, all the more as we age. A certain

degree of forgetfulness is normal for every age group,
especially in the elderly. That is not dementia. Some
people are naturally bad with names, telephone numbers
or addresses, as the case may be. That is 'normal' for
them and is not dementia either. Ask their families and
you will find that they have always been like that.
The worry is, when the memory loss exceeds what is
normal for the person's age, education or nature. In such
situations, a decline in dayto- day function may also be
noticed. Appointments may be forgotten and memos may
need to be kept. Shopping lists may be difficult to
remember. Things may be misplaced and lost a bit too
frequently. There may be difficulty remembering names
and even recognising people not seen for a few years.
Objects that have not been used recently may also be
forgotten.

Wrong names may be used. Some may start losing their way, initially
in unfamiliar and later in familiar places. They may have great
difficulty in locating their seats in a train or in flight, for example.

And gradually, even forget the way to their own home. Conversation
may be affected in many. Some cannot stop speaking while others
sit quietly by themselves with almost nothing to say. Some speak
with stutters and trip over words. Finding the right words may be
difficult for many of them. Reading and handwriting may be affected;
pronunciation and spelling errors may be prominent. Signing a
cheque could become a harrowing experience. Dressing, cooking,
handling a remote control, a mobile phone or a push-button
telephone may become difficult.

While any or all of these symptoms may be seen in

Alzheimer's disease, loss of memory is typically the most
prominent. Very often it is this loss of memory that draws
the attention of the caregivers and other close relatives.
At other times, a worried patient himself rings the doctor
first.

The memory
test
There are tests we can do to screen for Alzheimer's disease. Some of
these are simple questionnaires that take around 10 minutes to finish.
More detailed memory tests can be done later. Screening tests are
easy to administer, require minimum training for the tester and can be
performed at almost all settings like screening camps for Alzheimer's
disease, general outpatient clinics and special clinics exclusively set
up for memory disorders.
Besides picking out those with Alzheimer's disease or other forms of
dementia, memory tests help us separate those who do not have
dementia from those who have very mild memory impairments (mild
cognitive impairment or MCI). This last group is particularly important.
Most people with MCI will be forgetful - but only some will develop
Alzheimer's disease. Others may have mild but significant
forgetfulness for several years, while a few may even improve and be
back to normal. Identifying patients with MCI and trying to treat them
early is an area of major interest in Alzheimer's disease research today.

New horizon in
treatment
Until now, much of the treatment of Alzheimer's disease
has been symptomatic and not really geared to treat the
root cause. This is now changing. Current international
research is looking to find molecules that can act
against the very proteins that cause Alzheimer's
disease. Many such drugs are now in the pipeline
and could be expected to hit the shelves over the
next few years. These drugs seem to work best on
patients with early and mild Alzheimer's disease.
A heightened awareness and an early diagnosis of the
disease are therefore essential.

Lowering the risks

Can you reduce your risk of having Alzheimer's disease?
Researchers have been finding links between the occurrence
of Alzheimer's disease and diseases of the small blood vessels
of the brain.
MRI scans of the brain can sometimes pick up patchy, ministroke like areas in the brains of patients with Alzheimer's
disease. This has led to the suggestion that good food, lots of
green vegetables and an otherwise healthy lifestyle could
reduce the chances of having Alzheimer's disease much as it
reduces the risks of brain strokes and heart attacks. Turmeric,
frequently used in Indian food, is also believed to be one of
the protectors against Alzheimer's disease.

Caregivers'
care
Looking after the caregivers and their needs is as much a
part of Alzheimer's disease care as is looking after the
patient. In this regard our social service systems leave a
lot to be desired. The Alzheimer's disease and Related
Disorders Society of India (ARDSI), in its own way, is
trying its best to fill this vacuum. One day, drop in at one
of their offices, share a thought, and show them that you
care. Don't wait a whole year till the next World
Alzheimer's Day 2016 September 21st. Who knows how
long you will remember the 'forgotten ones'?

Dr Amitabha Ghosh is Senior Consultant Neurologist and

Honorary Consultant-in-charge, Memory Clinic, Alzheimer's
disease and Related Disorders Society of India at Apollo
Gleneagles Hospitals, Kolkata
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